Rationale for improving integrated service delivery: reduced cost and improved care in Georgia
In Georgia, non-communicable diseases (NCDs) constitute about 60% of total morbidity and mortality in the adult population, and acute respiratory tract infections (RTIs) are the most frequent reasons for seeking medical care among children. While effective interventions can prevent and treat NCDs and RTIs, appropriate care delivery remains very low due to fragmented health service delivery at each level of care and low compliance with evidence-based best practices. To improve quality of medical care for high-burden NCDs and RTIs in Georgia, the USAID-funded HCI and ASSIST projects worked closely with the Ministry of Health and other key stakeholders to apply quality improvement (QI) methods to improve integrated care in 17 ambulatory clinics and village solo practices and three hospitals in Georgia’s Imereti Region.
QI teams focused on improving integrated prevention and management of cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), and asthma and their cross-cutting risk factors in adult patients and on care of RTIs and asthma in children. The teams placed particular emphasis on improving care processes common to all diseases (diagnosis, severity assessment, case-management), coordination between levels of care and patient self-management support. Routine monitoring results after 34 months of project interventions showed that average compliance with evidence-based bundles of best practices in each priority clinical area ranged from 20-45% in May 2012 but improved by 55-80 percentage points, reaching compliance of over 89% by January 2015. Economic evaluation of the QI interventions found that while the total cost of the interventions was 155,921 USD during 18 months, the intervention saved 4 times more ($618,221) through decreased prescription/administration of non-evidence-based medications and diagnostic tests and simultaneously, increased the probability of receiving better quality of care.